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Urinary System > Intro to Urinary Tract Infections > Flashcards

Intro to Urinary Tract Infections Flashcards

1
Q

What are the different parts to the upper urinary tract?

A

Kidneys
• Parenchyma
• Pelvicalyceal system

Ureters
• Pelvic-ureteric junction
• Ureter
• Vesico-ureteric junction

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2
Q

What are the different parts to the lower urinary tract?

A 
Bladder 
Bladder outflow tract 
• Bladder neck (intrinsic urethral sphincter)
• Prostate 
• External urethral sphincter/pelvic floor 
• Urethra 
• Urethral meatus 
• Foreskin
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3
Q

What are different natures of renal diseases?

A
  • Infection
  • Inflammation
  • Iatrogenic
  • Neoplasia
  • Trauma
  • Vascular
  • Hereditary
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4
Q

Give an examples of renal infection

A

Pyelonephritis

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5
Q

Give an examples of renal inflammation

A

Glomerulonephritis, tubulointerstitial nephritis

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6
Q

Give an examples of iatrogenic renal disease

A

Nephrotoxicity, PCNL

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7
Q

Give an examples of renal Neoplasia

A

Renal tumours, collecting system tumours

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8
Q

Give an examples of renal trauma

A

Blunt trauma

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9
Q

Give an examples of vascular renal disease

A

Atherosclerosis, hypertension, Diabetes

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10
Q

Give an examples of hereditary renal disease

A

Polycystic kidney disease, nephrotic syndrome

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11
Q

What is the typical presentation of renal disease?

A
  • Pain
  • Pyrexia
  • Haematuria
  • Proteinuria
  • Pyuria (puss in urine)
  • Mass on palpation
  • Renal failure
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12
Q

What is the definition of proteinuria?

A

Urinary protein excretion >150mg/day

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13
Q

How many types of haematuria are there?

A

Two;
• Microscopic - only seen under a microscope
• Gross (or macroscopic)

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14
Q

Define microscopic haematuria

A

Found by urinalysis or urine dipstick; chronic or persistent if 5 or > RBCs per high-power field

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15
Q

Define oliguria

A

Urine output <0.5ml/kg/hour (low)

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16
Q

Define Anuria

A
  • Absolute anuria - No urine output

* Relative anuria - <100ml/24 hours

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17
Q

Define polyuria

A

Urine output >3L/24 hours (high)

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18
Q

Define nocturia

A

Waking up at night ≥1 occasion to micturate

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19
Q

Define nocturnal polyuria

A

Nocturnal urine output > 1/3 of total urine output in 24 hours

20
Q

Name common symptoms of UTIs

A
  • Dysuria (pain)
  • Frequency of urination
  • Suprapubic tenderness
  • Urgency
  • Polyuria
  • Haematuria
21
Q

What are the five stages in acute kidney injury?

A
  1. Risk
  2. Injury
  3. Failure
  4. Loss
  5. End-stage kidney disease
22
Q

Define the 1. Risk stage of acute kidney injury

A
  • Increase in serum creatinine level (x1.5)
  • Decrease in GFR by 25%
  • UO < 0.5 mL/kg/h for 6hrs
23
Q

Define the 2. Injury stage of acute kidney injury

A
  • Increase in serum creatinine level (x2)
  • Decrease in GFR by 50%
  • UO < 0.5mL/kg/h for 12hrs
24
Q

Define the 3. Failure stage of acute kidney injury

A
  • Increase in serum creatinine (x3)
  • Decrease in GFR by 75%
  • UO < 0.3mL/kg/h for 24hrs, or anuria for 12hrs
25
Q

Define the 4. Loss stage of acute kidney injury

A
  • Persistent acute renal failure

* Complete loss of kidney function > 4 weeks

26
Q

Define the 5. End-stage kidney disease stage of acute kidney injury

A

Complete loss of kidney function > 3 months

27
Q

What are the six functions of the kidney?

A
  • Body fluid homeostasis
  • Electrolyte homeostasis
  • Acid-base homeostasis (excrete H and generate HCO3)
  • Regulation of vascular tone
  • Excretory (urea, drugs etc)
  • Endocrine functions
28
Q

What are the endocrine functions of the kidneys?

A
  • Erythropoeitin
  • Vit D metabolism
  • Renin
29
Q

What are the symptoms and signs of chronic renal failure?

A
  • Asymptomatic (found via blood and urine testing)
  • Tiredness
  • Anaemia
  • Oedema
  • High blood pressure
  • Bone pain due to renal bone disease
In advanced Renal failure:
• Pruiritus 
• Nausea/vomiting 
• Dyspnoea 
• Pericarditis 
• Neuropathy 
• Coma
30
Q

Give an example of iatrogenic/trauma ureteric disease

A

Inadvertently cut or tied during hysterectomy or colon resection

31
Q

Give an example of ureteric neoplasia

A
  • Transitional cell cancer (TCC) of ureter
  • TCC of bladder obstructing VUJ
  • Prostate cancer obstructing VUJ
  • Pelvic malignancy
  • Pelvic or para-aortic lymphadenopathy
32
Q

Give an example of hereditary ureteric disease

A
  • Pelvic-ureteric junction (PUJ) obstruction

* Vesico-ureteric junction (VUJ) reflux

33
Q

Give an examples of causes of ureteric obstruction

A
  • Intra-luminal (stone, blood blot)
  • Intra-mural (scar tissue, TCC)
  • Exrta-luminal (pelvic mass, lymph nodes)
34
Q

What is the typical presentation of ureteric disease?

A
  • Pain (eg. renal colic)
  • Pyrexia
  • Haematuria
  • Palpable mass (ie. hydronephrosis)
  • Renal failure (only if bilateral obstruction or single functioning kidney)
35
Q

What is the typical presentation of bladder diseases?

A
  • Pain (suprapubic)
  • Pyrexia
  • Haematuria
  • Lower urinary tract symptoms (LUTS)
  • Recurrent UTIs
  • Chronic urinary retention (due to bladder underactivity)
  • Urinary leak from vagina (i.e. vesico-vaginal fistula)
  • Pneumaturia (i.e. colo-vesical fistula)
36
Q

What are the lower urinary tract symptoms of bladder diseases?

A
  • Storage LUTS (i.e. frequency, nocturia, urgency, urge incontinence)
  • Voiding LUTS (i.e. poor flow, intermittency, terminal dribbling) – due to underactive bladder
  • Incontinence (stress, urge, mixed, overflow, neurogenic, dribbling, etc.)
37
Q

Give examples of the different nature of bladder diseases and their causes

A

Infection - cystitis

Inflammation - interstitial cystitis, colonic diverticulitis resulting in colo-vesical fistula

Iatrogenic/Trauma - bladder rupture, bladder injury from hysterectomy (resulting in vesico-vaginal fistula)

Neoplasia - TCC of bladder, squamous cell carcinoma of bladder

Idiopathic - overactive bladder syndrome

Degenerative - chronic urinary retention

Neurological - neurogenic bladder dysfunction

38
Q

Describe the control of micturition

A

1) Cortical centre (bladder sensation and conscious inhibition of micturition)
2) Pons (micturition centre)
3) Sacral segments (S2-S4) (micturition reflex):
• Relaxation of internal urethral sphincter (autonomic - sympathetic)
• Relaxation of external urethral sphincter (somatic)
• Contraction of detrusor muscle (autonomic – parasympathetic)

39
Q

What are possible causes of LUTS?

A

• Bladder pathology (OAB, UTI, interstitial cystitis, bladder cancer)
• Bladder outflow obstruction
• Pelvic floor dysfunction
• Neurological causes (i.e. neurogenic bladder dysfunction):
- Supra-pontine lesions (i.e. stroke, alzheimers, parkinsons)
- Infra-pontine supra-sacral lesions (i.e. spinal cord injury, disc prolapse, spina bifida)
- Infra-sacral (i.e. MS, diabetes, cauda equina compression)
• Systemic disorders (i.e. chronic renal failure, cardiac failure, diabetes mellitus, diabetes insipidus)

40
Q

What are the two stages in the micturition cycle?

A
  1. Storage (or filling) phase

2. Voiding phase

41
Q

What are the different natures of bladder outflow tract diseases?

A

Infection/Inflammation - prostatitis, balanitis

Iatrogenic/Trauma - pelvic floor damage after traumatic vaginal delivery or hysterectomy, urethral injury from catheterisation or pelvic fracture

Neoplasia - prostate cancer, penile cancer

Idiopathic - chronic pelvic pain syndrome

Obstruction:
• Primary bladder neck obstruction 
• Benign prostatic enlargement (BPE) causing obstruction
• Urethral stricture
• Meatal stenosis
• Phimosis
42
Q

What is the presentation on bladder outflow tract disease?

A 
• Pain (suprapubic or perineal)
• Pyrexia
• Haematuria
• Lower urinary tract symptoms (LUTS)
- Voiding LUTS (i.e. hesitancy, intermittency, poor flow, terminal dribbling, incomplete bladder emptying) due to Bladder Outflow Obstruction (BOO)
- Overflow incontinence (high-pressure chronic urinary retention)
- Stress urinary incontinence
• Recurrent UTIs
• Acute urinary retention
• Chronic urinary retention
43
Q

What is acute urinary retention?

A

Defined as painful inability to void with a palpable and percussible bladder
• 500ml to 1L

44
Q

What are causes for acute urinary retention?

A

Main risk is Benign Prostatic Obstruction (BPO) but can also occur independently of BPO (i.e. UTI, urethral stricture, alcohol excess, post-op)

For those with BPO, usually triggered by unrelated event (i.e. constipation, alcohol excess, post-op)

45
Q

What is the treatment of acute urinary retention?

A
  • Immediate treatment is catheterisation

* Also treat underlying cause

Urinary System (31 decks)

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